{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:06Z","timestamp":1788847686767,"version":"build-2803163510"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"UK National Institute of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Global Health Group funding","award":["NIHR133850"],"award-info":[{"award-number":["NIHR133850"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The mortality rate of surgical patients in Africa is twice the global average. Pan-African studies have identified that this excess mortality is driven by deaths arising from postoperative complications. Preventable deaths can be reduced with enhanced monitoring in the postoperative period. This study reports on the first of a two-phase Quality Improvement (QI) programme, \u20185 Rs to Rescue\u2019, designed to reduce failure to rescue for surgical patients in Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a QI approach, we co-produced a failure to rescue intervention with stakeholders across four African countries (Ethiopia, South Africa, Tanzania, and Uganda). These initial interventions were as follows: (i) Risk assessment using a validated tool, (ii) Recognition of patient deterioration using an early warning system (EWS), (iii) Response to patient deterioration (using locally defined protocols, (iv) Reassessment using an EWS, and (v) Reflection on care provided. These were tested and refined in clinical practice at nine hospitals through QI approaches. We interviewed frontline staff, project leaders, and QI advisors at the end of Phase 1 to learn from their experience to refine the intervention prior to Phase 2. Deductive thematic analysis was used, sensitized by constructs from the Consolidated Framework for Implementation Research (CFIR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We interviewed 11 frontline staff, seven national project leads and five QI advisors. From the CFIR-based coding, two cross-cutting, higher-order themes were developed to describe the participant\u2019s experience. Theme 1 centred around the substantial relational work involved in leading the 5Rs project. Surgeons reported the recurrent communication required to engage, train, and motivate all the necessary stakeholders. Surgical and nursing hierarchies were poorly linked in many settings, initially hampering these relational efforts. Theme 2 centred on the complexity of the 5Rs tools being introduced into complex, and already overstretched systems. A long period was required for nurses and doctors to become familiarized with the proposed \u20185Rs\u2019 tools. Although their value was broadly accepted, not all tools were a good fit for all the project settings. Potential solutions to overcome barriers identified in Phase 2 included a longer QI programme, more emphasis on involving nurse leaders and selection of a less complicated \u2018EWS\u2019 for detecting patient deterioration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Developing a multifaceted intervention that fits within complex, resource-limited contexts is a major challenge for efforts to improve patient care. This Phase 1 evaluation has provided actionable learning, targeting specific barriers, to be incorporated into an improved failure to rescue QI programme being developed in Phase 2.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag110","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:32:37Z","timestamp":1786707157000},"source":"Crossref","is-referenced-by-count":0,"title":["Improving surgical patients\u2019 safety in African hospitals: exploring healthcare professionals\u2019 experiences of Phase 1 of the \u20185Rs to Rescue\u2019 programme"],"prefix":"10.1093","volume":"38","author":[{"given":"Charles","family":"Fadipe","sequence":"first","affiliation":[{"name":"Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Duys","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town , Cape Town,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian J","family":"Bedwell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town , Cape Town,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0963-0899","authenticated-orcid":false,"given":"Pierre","family":"Barker","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Improvement (IHI) , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Barabona","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Muhimbili University of Health and Allied Sciences , Dar es Salaam,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce M","family":"Biccard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town , Cape Town,","place":["South Africa"]},{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Ellis","sequence":"additional","affiliation":[{"name":"Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6019-2441","authenticated-orcid":false,"given":"Adam","family":"Hewit-Smith","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford,","place":["United Kingdom"]},{"name":"Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Busitema University , Mbale,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fitsum","family":"Kilfe","sequence":"additional","affiliation":[{"name":"Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town , Cape Town,","place":["South Africa"]},{"name":"Network for Perioperative and Critical Care, Debre Birhan University Asrat Woldeyes Health Sciences Campus , Debre Birhan, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne E","family":"McPherson","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Improvement (IHI) , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busisiwe","family":"Mrara","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Critical Care, Walter Sisulu University , Mthatha, Eastern Cape,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezile","family":"Ninise","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Critical Care, Walter Sisulu University , Mthatha, Eastern Cape,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert M","family":"Pearse","sequence":"additional","affiliation":[{"name":"Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London , London,","place":["United Kingdom"]},{"name":"Adult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Shayo","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Muhimbili University of Health and Allied Sciences , Dar es Salaam,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J","family":"Stephens","sequence":"additional","affiliation":[{"name":"Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London , London,","place":["United Kingdom"]},{"name":"Adult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust , London,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"APPRISE Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Adem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fitsum Kifle","family":"Belachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tizeta","family":"Belachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermiyas","family":"Belay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yared Boru","family":"Firissa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirunesh Busha","family":"Gemechu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abiy","family":"Dawit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brook","family":"Demissie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Degisew Dersso","family":"Mengistu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kokeb","family":"Desta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelem","family":"Desta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desta","family":"Galcha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuroadis","family":"Guchima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peniel","family":"Kenna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tewodros","family":"Kifleyohanes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betelehem Mulye","family":"Zewde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bezaye","family":"Zemdkun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalkidan","family":"Kifleyohanes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfay","family":"Yohannes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getaneh","family":"Dejen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antenehe","family":"Mitku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulegeta","family":"Kassahun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mintesnot Lemi","family":"Woldetnesy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026090801422762500_mzag110-B1","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1016\/S0140-6736(18)30001-1","article-title":"Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study","volume":"391","author":"Biccard","year":"2018","journal-title":"Lancet"},{"key":"2026090801422762500_mzag110-B2","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/S0140-6736(18)33139-8","article-title":"Global burden of postoperative death","volume":"393","author":"Nepogodiev","year":"2019","journal-title":"Lancet"},{"key":"2026090801422762500_mzag110-B3","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.surg.2014.10.017","article-title":"A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery","volume":"157","author":"Johnston","year":"2015","journal-title":"Surgery"},{"key":"2026090801422762500_mzag110-B4","doi-asserted-by":"publisher","first-page":"e1391","DOI":"10.1016\/S2214-109X(21)00291-6","article-title":"Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial","volume":"9","author":"Biccard","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026090801422762500_mzag110-B5","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.bja.2021.07.001","article-title":"Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial","volume":"127","author":"Vickery","year":"2021","journal-title":"Br J Anaesth"},{"key":"2026090801422762500_mzag110-B6","doi-asserted-by":"publisher","first-page":"m1501","DOI":"10.1136\/bmj.m1501","article-title":"Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology","volume":"369","author":"Gerry","year":"2020","journal-title":"BMJ"},{"key":"2026090801422762500_mzag110-B7","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1001\/archinternmed.2009.424","article-title":"Rapid response teams: a systematic review and meta-analysis","volume":"170","author":"Chan","year":"2010","journal-title":"Arch Intern Med"},{"key":"2026090801422762500_mzag110-B8","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1016\/S0140-6736(05)66733-5","article-title":"Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial","volume":"365","author":"Hillman","year":"2005","journal-title":"Lancet"},{"key":"2026090801422762500_mzag110-B9","volume-title":"The Breakthrough Series: IHIs Collaborative Model for Acheiving Breakthrough Improvement","author":"Improvement IoH","year":"2003"},{"key":"2026090801422762500_mzag110-B10","doi-asserted-by":"publisher","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"2026090801422762500_mzag110-B11","doi-asserted-by":"publisher","first-page":"2993","DOI":"10.1007\/s00268-021-06208-y","article-title":"The impact of quality improvement interventions in improving surgical infections and mortality in low and middle-income countries: a systematic review and meta-analysis","volume":"45","author":"Jin","year":"2021","journal-title":"World J Surg"},{"key":"2026090801422762500_mzag110-B12","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s13012-018-0712-2","article-title":"Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review","volume":"13","author":"Zaka","year":"2018","journal-title":"Implement Sci"},{"key":"2026090801422762500_mzag110-B13","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1093\/intqhc\/mzt093","article-title":"The use of modern quality improvement approaches to strengthen African health systems: a 5-year agenda","volume":"26","author":"Heiby","year":"2014","journal-title":"Int J Qual Health Care"},{"key":"2026090801422762500_mzag110-B14","author":"APPRISE, Research and Group","year":"2024"},{"key":"2026090801422762500_mzag110-B15","author":"Ellis","year":"2024"},{"key":"2026090801422762500_mzag110-B16","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.bja.2018.08.005","article-title":"The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications","volume":"121","author":"Kluyts","year":"2018","journal-title":"Br J Anaesth"},{"key":"2026090801422762500_mzag110-B17","doi-asserted-by":"publisher","first-page":"e0144801","DOI":"10.1371\/journal.pone.0144801","article-title":"Vital signs directed therapy: improving care in an intensive care unit in a low-income country","volume":"10","author":"Baker","year":"2015","journal-title":"PLoS One"},{"key":"2026090801422762500_mzag110-B18","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1097\/CCM.0000000000002000","article-title":"A comparison of the ability of the physiologic components of medical emergency team criteria and the U.K. National Early Warning Score to discriminate patients at risk of a range of adverse clinical outcomes","volume":"44","author":"Smith","year":"2016","journal-title":"Crit Care Med"},{"key":"2026090801422762500_mzag110-B19","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1111\/milq.12016","article-title":"Understanding the components of quality improvement collaboratives: a systematic literature review","volume":"91","author":"Nadeem","year":"2013","journal-title":"Milbank Q"},{"key":"2026090801422762500_mzag110-B20","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual Health Res"},{"key":"2026090801422762500_mzag110-B21","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm Policy Ment Health"},{"key":"2026090801422762500_mzag110-B22","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"2026090801422762500_mzag110-B23","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J Adv Nurs"},{"key":"2026090801422762500_mzag110-B24","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"2026090801422762500_mzag110-B25","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement Sci"},{"key":"2026090801422762500_mzag110-B26","doi-asserted-by":"publisher","first-page":"e074256","DOI":"10.1136\/bmj-2022-074256","article-title":"Practical thematic analysis: a guide for multidisciplinary health services research teams engaging in qualitative analysis","volume":"381","author":"Saunders","year":"2023","journal-title":"BMJ"},{"key":"2026090801422762500_mzag110-B27","doi-asserted-by":"publisher","first-page":"e006140","DOI":"10.1136\/bmjgh-2021-006140","article-title":"How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco","volume":"6","author":"Belrhiti","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2026090801422762500_mzag110-B28","doi-asserted-by":"publisher","first-page":"2876","DOI":"10.34172\/ijhpm.2022.6097","article-title":"Power dynamics among health professionals in Nigeria: a case study of the global fund policy process","volume":"11","author":"Lassa","year":"2022","journal-title":"Int J Health Policy Manag"},{"key":"2026090801422762500_mzag110-B29","doi-asserted-by":"publisher","first-page":"15358","DOI":"10.1002\/cam4.6087","article-title":"Stages of change: strategies to promote use of a pediatric early warning system in resource-limited pediatric oncology centers","volume":"12","author":"Woo","year":"2023","journal-title":"Cancer Med"},{"key":"2026090801422762500_mzag110-B30","doi-asserted-by":"publisher","first-page":"e221547","DOI":"10.1001\/jamanetworkopen.2022.1547","article-title":"Assessment of barriers and enablers to implementation of a pediatric early warning system in resource-limited settings","volume":"5","author":"Agulnik","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026090801422762500_mzag110-B31","doi-asserted-by":"publisher","first-page":"e0000225","DOI":"10.1371\/journal.pgph.0000225","article-title":"Implementation and evaluation of obstetric early warning systems in tertiary care hospitals in Nigeria","volume":"2","author":"Umar","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026090801422762500_mzag110-B32","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/1748-5908-6-124","article-title":"Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals\u2014interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies","volume":"6","author":"English","year":"2011","journal-title":"Implement Sci"},{"key":"2026090801422762500_mzag110-B33","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/s1070-3241(02)28051-7","article-title":"Microsystems in health care: Part 1. Learning from high-performing front-line clinical units","volume":"28","author":"Nelson","year":"2002","journal-title":"Jt Comm J Qual Improv"},{"key":"2026090801422762500_mzag110-B34","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1111\/j.1468-0009.2011.00625.x","article-title":"Explaining Michigan: developing an ex post theory of a quality improvement program","volume":"89","author":"Dixon-Woods","year":"2011","journal-title":"Milbank Q"},{"key":"2026090801422762500_mzag110-B35","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1038\/s44360-026-00058-5","article-title":"African-led health innovation and investment can build a prosperous continent","volume":"1","author":"Janabi","year":"2026","journal-title":"Nat Health"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/intqhc\/advance-article-pdf\/doi\/10.1093\/intqhc\/mzag110\/70651087\/mzag110.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/3\/mzag110\/70651087\/mzag110.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/intqhc\/article-pdf\/38\/3\/mzag110\/70651087\/mzag110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:42:32Z","timestamp":1788846152000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/doi\/10.1093\/intqhc\/mzag110\/8761703"}},"subtitle":[],"editor":[{"given":"Reece","family":"Hinchcliff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7,8]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzag110","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"value":"1353-4505","type":"print"},{"value":"1464-3677","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"mzag110"}}